- CMS Administrator Seema Verma recently admitted some federal regulations do not make sense and stated the organization will prioritize consolidating quality measures to lessen provider burden.
Verma outlined the ways CMS intends to tackle provider burden and regulatory complexity along with other issues including EHR usability and interoperability at the 2017 ONC Annual Meeting in Washington, DC. Verma sat down with ONC National Coordinator for Health Information Technology Donald Rucker, MD to discuss current problems with regulatory burden as well as potential solutions.
“CMS is one of the agencies that contributes — one of the top agencies in terms of the regulations that we put out,” stated Verma. “CMS puts out 11,000 pages [of regulations] a year.”
“One of the things we are finding is that even with regulation that we have in individual areas — we have one for outpatient, inpatient — but we don’t think about how all the regulation and rules come together for one system,” she continued. “So we started this at CMS where we have interdisciplinary teams working on this.”
As part of its efforts to reduce regulatory burden, CMS has launched initiatives including Meaningful Measures and Patients Over Paperwork.
“We have a new initiative called patients over paperwork and it really addresses that core issue of the massive regulatory burden that CMS is a large part in,” she said.
Patients Over Paperwork is designed to serve as a collaborative process for evaluating and streamlining regulations to minimize regulatory burden, increase efficiency, and improve the beneficiary experience. The initiative will focus on boosting the amount of time providers spend interacting with patients to reduce the risk of physician burnout.
Meanwhile, Meaningful Measures is intended to ensure quality metrics only involve evaluating core issues.
"We know we have 60 some measures for hospitals, and we have another 100 there,” said Verma. “We are working towards trying to consolidate a lot of the measurement, trying to make sure that they align across the system.”
Verma clarified the push to consolidate measures is not intended to suggest that only a few quality measures are important. Instead, CMS is trying to be mindful of how many measures providers are able to realistically focus on and take some of the stress of reporting off the provider workload. The quality measures that remain should be outcomes-based to accommodate the value-based care system.
“A lot of the measures in terms of how we are evaluating providers are not necessarily around outcomes,” stated Verma. “There’s a lot of process measures. And so as we go forward with paying for quality, the idea is – what is quality and what is value? How do we measure that? We want to move away from process measures and really focus on the outcomes.”
In addition to reducing the number of quality measures providers are required to report, Verma also stated CMS wants to make the process of reporting easier on providers.
“The information that is being reported needs to come from the EHR and in an electronic way, but what are we hearing — and it actually kind of turned my stomach when I heard about it — this hospital that hired 18 to 20 people just to be able to report,” shared Verma. “That's where I feel like this is not working well.”
In order to ease frustrations surrounding reporting, Verma stated health IT developers and providers need to work together to improve EHR usability and interoperability. Both aspects of EHR use were framed as the two biggest issues ONC intended to address in the latter half of 2017 during an ONC press conference in July.
“As we talk about regulatory issues in burden one issue we've heard about over and over again around many communities is the issues around medical records and interoperability,” she said. “Many of our providers talk about the system that they are working with and say it was not built for them in terms of how they are delivering care to their patients. It is more suited to a billing system.”
In order to enable interoperability and improve EHR usability, Verma stressed the need for health IT innovators to develop an EHR that is responsive to providers.
“I think it is a matter of how they were designed,” stated Verma.
She recommended more health IT companies and developers sit down with physicians during the implementation process to ensure EHR system design is tailored to meet physician needs. This level of customization could help to skew EHR systems more toward assisting with patient care delivery rather than serving billing purposes.
"We need to reset and think about how to go forward," said Verma.